Despite years of awareness, the Estonian government and Riigikogu are failing to provide timely support for people with psychiatric conditions, according to a recent audit.
The Social Insurance Board (SKA) and Ministry of Social Affairs are failing to meet their legal obligation to provide special care services for people with psychiatric conditions, the National Audit Office found in its latest audit.
Although the budget for special care has remained stable, rising demand has made services increasingly inaccessible. The government and Riigikogu have known of the problem for years but have not acted.
“There is a severe shortage of service places for people with intellectual disabilities and mental health conditions,” said National Audit Office audit manager Rauno Vinni.
He noted that waitlists for special care services have nearly doubled from 2018 to 2024, pushing median wait times to anywhere from 14 months to nearly four and a half years. The longest waits are for 24-hour services for those with high support needs, which some may never access.
Representative organizations reported cases where finding a suitable placement took years. One young Autistic adult waited four years while multiple placements failed due to mismatched needs or providers unable to deliver services.
Families also often require legal aid as they navigate dealing and communicating with authorities, and some have sought help abroad, hoping to access needed support sooner.
Accessing a state service should not require hiring a lawyer or going abroad, Vinni emphasized.
SKA not explaining delays to patients
By law, special care should prioritize individual need. In practice, however, availability depends on funding and service slots. Meanwhile, Vinni noted, people’s needs remain, and worsen without access to the necessary services.
According to the National Audit Office, delays must be explained to individuals, yet SKA does not provide any regarding the lack of funding or service places.
“The Board replied that they treat all people on the waiting list equally,” the audit manager noted, criticizing the lack of answers as undignified treatment.
“People are waiting for the assistance from the state that has been assigned to them, and they deserve at least an honest explanation as to why they don’t receive it within a reasonable timeframe,” he added.
A 2013 Tallinn Circuit Court ruling suggested three months is a reasonable period for SKA to secure funding after a service decision, yet people still wait years.
The National Audit Office stressed that the state cannot shift responsibility to local authorities while failing to meet its own obligations either, especially when requests for additional funding have not increased service volume or quality.
Developing the field will require making offerings more needs-based and streamlining waitlists. Progress has stalled for years due to limited funding and attention, but beyond money, the field needs substantive reforms, and the Social Affairs Ministry’s future plans will require greater decisiveness.
For more details, see the full press release from the National Audit Office.
—